"HHS" Health and Human Services Issue Health Care Exchange Rules

WASHINGTON -- The Department of Health and Human Services has issued the final regulations for implementing the state health insurance exchanges mandated by the Affordable Care Act (ACA).

They allow states more flexibility in determining eligibility for the exchanges than was first given, according to Chiquita Brooks-LaSure, director of coverage policy in HHS' Office of Health Reform. That change was made after "a lot of input from states and stakeholders," she told reporters on a Monday afternoon conference call.

The setup of the exchanges "lets consumers easily determine their eligibility for enrollment and easily enroll in coverage that's right for them," said Brooks-LaSure. That includes using a single streamlined application so that consumers will get a "consistent eligibility determination" without needing to submit different information for the different plans offered.

Under the ACA, nearly everyone is required to have insurance starting in 2014, and the government will provide financial assistance to those who need it. People who earn less than 133% of the federal poverty level can enroll in Medicaid, and those who are between 133% and 400% of the poverty level will be eligible for tax credits from the federal government in order to buy insurance.

People can use the tax credit to buy health insurance through an exchange in their state. The exchanges will act as "one-stop shops" where people can compare different insurance plans.

For small employers -- such as small physician practices -- that want to provide health insurance for their employees, the exchanges also will offer a Small Business Health Options Program (SHOP).

SHOP will let small businesses choose among different levels of coverage, depending on what works for them and their budget. SHOP will allow these employers to offer coverage from a number of insurers, but still get one bill and write only one check, according to HHS.

The SHOP program also features tax credits to help make coverage easier for small businesses to afford.

According to HHS, starting in 2014, small employers purchasing coverage through SHOP may be eligible for a tax credit of up to 50% of their premium payments if they:
Have no more than 25 employees  
Pay employees an average annual   wage of less than $50,000
Offer all full-time employees   coverage
Pay at least 50% of the   premium

Payroll and Compensation, Your Time or Their Time?

The time that employers must pay for isn't always clear. To help make sense of the confusion, here are answers to some frequently asked questions about when companies have to pay employees based on Labor

What States Require

Most states have labor regulations similar or the same as federal labor regulations. Click here to see what your state labor department requires.

The Supreme Court Weighs In

The Supreme Court took up the issue of compensable time in a case involving employees of meat production and poultry plants who were required to put on protective gear and walk to the production floor at the start of each day. At the end of the day, they had to walk back to the locker room and take off the gear.

The issue before the Court was whether the time walking to and from the production floor should be paid time. The Court held the time to actually "don" and "doff" the gear was compensable, under the Fair Labor Standards Act.

The employees asserted that their workday began once they put on the gear. The employers maintained that the walking time was a commute or a break.

The Justices applied the "continuous workday" principle, which states that compensable time begins with the first principal activity of the day and ends with the last principal activity.

Because wearing the equipment was mandatory, the court ruled that the first and last principal activities were donning and doffing the gear. Time in between was work time that had to be paid for.

   

However, the court ruled against the employees on another issue: Sometimes employees would have to wait until protective gear was available. Applying the same "continuous workday" principle, the court ruled that because "wait time occurred before the first principal activity, the employer wasn't obliged to pay for that time. (IBP, Inc., vs. Gabriel Alvarez, et al, No. 03-1238, Nov. 8, 2005)

Department regulations:

Q.

Do We Have to Pay Employees On Call?

Yes, your company is required to pay employees if you require them to remain on your premises while they wait for an assignment (for example, firefighters waiting for an emergency call). If this is the case, they are considered to be working and must be paid, even if they are doing other things, such as playing cards.

No, you don't have to pay employees if you allow them to go home and they are free to leave messages saying where they can be reached. In most cases like these, the employees are not considered to be working.

Yes, you must pay employees if you allow them to leave but restrict their activities, (such as requiring them to remain close to the workplace or not drink alcohol while on call).

Q.

Do We Have to Pay for Travel Time?

No, you do not have to pay employees for the time they spend commuting back and forth from home.

Yes, you have to pay for travel time if you have maintenance employees who use their own cars every day to travel to your branch offices in neighboring cities. You pay for time between locations.

Q.

Do We Have to Pay for Meal Time and Rest Breaks?

Yes, you do have to pay if the employee continues working during lunch or rest breaks. For example, if your receptionist spends her lunchtime at her desk, answering the phone as usual and has not been relieved of her duties, you do have to pay her for the time. What if she works during lunch breaks against your instructions? It's up to you to enforce the rules.

State laws regulate break periods, including the minimum time required for meals and rest breaks and whether the time must be paid. But even states that don't require paid breaks do require employers to pay employees if job duties are performed during long breaks, such as lunch or rest periods during long shifts.

Q.

Do We have to Pay for Sleep Time?

Yes, you must pay for sleep time if employees sleep less than five hours or are on duty for less than 24 hours. They are considered to be working for those hours, even if they are allowed to sleep or engage in other personal activities during non-busy times.

No, you don't have to pay if your employees work 24 hours or more and you have an agreement that their work hours will exclude bona fide regularly scheduled sleep periods for not more than eight hours - as long as you provide sleeping facilities and they can generally sleep uninterrupted.

Intersting Statistics to Help Your Companies Marketing Objectives

Some interesting statistic’s for those of you looking at our under and over age 65 population.

This could help direct your companies future marketing objectives.



38.9 million was the number of people 65 and older in the United States on July 1, 2008.
88.5 million is the projected number of people 65 and older in 2050.
$29,744 was the median 2008 income for householders 65 and older. The corresponding median income for all households was $50,303.
$239,400 was the median net worth for families in 2007 whose head of household was between 65 and 74. The corresponding median net worth for all families was $120,300.
80% of those 65 and older owned their homes in 2008.
What’s it mean?
The Senior population is growing like wild as Baby Boomers hit 65 and will continue to grow!
Although Seniors’ incomes are less than other population groups, their net worth is considerably higher.
A large percentage of Seniors own their homes, making them a stable population group.
Seniors have money and stability.

Source: http://seniorjournal.com/; http://en.wikipedia.org/wiki/Homeownership_in_the_United_States

Under the Privacy Rule, employer health plans that are not in compliance can face new civil and criminal penalties.

These penalties are based on a tiered approach, as follows: 

·   No Knowledge.  Where a person does not know, and by exercising due diligence would not have known, that the person violated HIPAA's administrative simplification provisions; the minimum penalty is $100 per violation, with a cap of $25,000 for violations of an identical requirement or prohibition.  The maximum penalty is $50,000 per violation, with a cap of $1.5 million for violations of an identical requirement or prohibition. 

 ·   Reasonable Cause. Where a violation is due to "reasonable cause" and not "willful neglect," the minimum penalty is $1,000 per violation, with a cap of $100,000 for violations of an identical requirement or prohibition.  The maximum penalty is $50,000 per violation, with a cap of $1.5 million for violations of an identical requirement or prohibition. 

 

·    Willful Neglect (but Corrected).  Where a violation is due to "willful neglect," but was corrected, the minimum penalty is $10,000 per violation, with a cap of $250,000 for violations of an identical requirement or prohibition.  The maximum penalty is $50,000 per violation, with a cap of $1.5 million for violations of an identical requirement or prohibition. 

·   Willful Neglect (but not Corrected). Where a violation is due to "willful neglect," but was not corrected, the minimum penalty is $50,000 per violation, with a cap of $1.5 million for violations of an identical requirement or prohibition.  Additionally, there can be individual penalties of as much as $25,000 per violation or up to $250,000 or 10 years in prison for information knowingly and wrongfully disclosed.